Coning tool for cervical surgery



OC- 10, 1957 E. s. HoDGEs 3,345,981

CONING TOOL FOR CERVICAL SURGERY Filed Jan. 29, 1965 l INVENTOR United States Patent O 3,345,981 CONING TOOL FOR CERVICAL SURGERY Earnest S. Hodges, Nashville, Tenn., assignor to .l.M.P. Corp., Nashville, Tenn., a corporation of Tennessee Filed `lan. 29, 1965, Ser. No. 429,096 9 Claims. (Cl. 1282) ABSTRACT OF THE DISCLOSURE A medical instrument is provided for use in cold conization of a cervical os, and the instrument includes (1) a main body portion which can be held in one hand and placed into proper position for obtaining a tissue sarnple, and (2) a blade means carried in a guide means which can be rotated 360 about the longitudinal axis of the instrument so .as to permit a removal of a continuous strip of tissue about the inner surface of a cervical os.

This invention relates to a surgical instrument for obtaining a tissue specimen from a body cavity, and more particularly the invention relates to an instrument for cold conization of the cervix.

The instrument of this invention is especially Well adapted for removing a circumferential specimen of tissue from the cervical os for the purpose of diagnosis of and ultimate treatment of cancer of the cervix. As is well known in the medical arts, cancer of the cervix may be detected by examining tissue samples of the cervical epithelium, and it has become the accepted practice to take such samples in the physical examination of women of cancer age.

Various surgical instruments have been proposed for performing the cutting operation described above, but these instruments have had certain disadvantages in their limited cutting capabilities and in the diiliculty of manipulating them in actual use.

The particular construction of the surgical instrument of this invention provides for the cutting blade to be mounted at a predetermined angle to the longitudinal axis of the instrument, and the instrument with its blade is then adapted for removing a strip of tissue from the internal circumference of a body cavity, such as from the cervical os of the uterus.

The mounting means for the cutting blade includes a blade guide which is rotatably mounted on the instrument and which maintains the blade in a xed angular relationship to the instrument. At the same time, the blade guide permitts the blade to be rotated about the longitudinal axis of the instrument so that a 360 sampling of the epithelium may be removed from the cervix. With the construction of this invention the instrument may be inserted, and the sample taken, with greater manipulative ease then heretofore possible, and the cut-ting action of this instrument provides a better tissue sample for pathological evaluation.

It is a further feature of this invention that the blade guide of the instrument is easily interchangeable, whereby a variety of predetermined cutting angles may be provided on the same instrument. Thus, the same instrument may be used for removing greater or lesser amounts of tissue, or the instrument may be adapted to varying sizes and conditions of cervical cavities for obtaining the requisite amount of tissue for the usual diagnosis of cancer.

The blade is maintained in position by the blade guide associated with the instrument of this invention, but the lblade is rotated about the longitudinal axis of the instrument by a blade holding means used in conjunction with this instrument. This blade holding means provides for the blade to be easily rotated about the circumference of the cervical os by a single operator while the instru- 3,345,981 Patented Oct. 10, 1967 ment is being held in position by the same operator. Furthermore, the blade holding means is provided with a gripping device which may be used to grasp the anterior lip of the cervix while tissue is being removed from the cervical os. Prior to this invention, it has been necessary for an assistant to hold the cervix with separate clamping or gripping means While the operator removed tissue with a cutting instrument. With this invention, it is possible for a single operator to hold the cervix and to remove tissue with a single instrument.

The blade which is used in this instrument is replaceable and has a double cutting edge. This permits the cutting action to be elfected in either direction of movement of the blade at the choice of the operator. Having a replaceable blade in the instrument allows the instrument to be adapted to varying cutting requirements by substituting different blades with diilerent cutting characteristics. Furthermore, the blade may be easily discarded and replaced when dull, and the instrument may be continued in use.

In addition to advantages in construction and use which will be apparent from the above discussion, the present invention has the advantage of being assembled from a plurality of simple elements. These elements may be easily disassembled for sterilizing the instrument and for interchanging like elements of varying dimensions, so that the instrument may be tted to a wide range of uses. Other advantages will appear from the accompanying drawings in which:

FIGURE 1 is a plan View of the surgical instrument together with the blade holding device used in conjunction with the instrument;

FIGURE 2 is a longitudinal section of the view shown in FIGURE 1;

FIGURE 3 is a section of an interchangeable blade guide for use with the instrument of FIGURES 1 and 2; and

FIGURE 4 is a perspective view of the instrument with the various elements exploded to more clearly illustrate their form and relationship.

Referring to the drawings, and more particularly to FIGURES 1, 2 and 4, the cold conization instrument has a stem 10 which may be of any suitable length and which includes a tip end and a handle end.

The handle end of the stem 10 may be provided with a removably mounted handle 12 and the tip end of the stem includes a tip 14 which is preferably formed integrally with the stem 10. Intermediate the handle end and the tip end of the stern is a series of sleeve-like elements which are lassembled on the stem 10 in a particular arrangement to be described. These elements include a blade guide 16 and spacer elements 18 and 20. The instrument is assembled by starting with the elongated stem 10 with its integral tip 14 and by sliding the sleeve-like spacer element 18 onto the stem from the handle end of the stem, Then the blade guide 16 is added, together with the spacer element 20, and lastly the handle 12 is secured to the end of the stem to hold the elements in their respective positions on the stem.

As discussed above, the tip 14 is preferably formed integrally with the stem 10, but it may be formed separately and secured to the end of the stern in any suitable manner, as by threading it to the end of the stem. The tip 14 includes a shoulder 22 which is of -a larger diameter than the stern 10, but is smaller in diameter than the tip itself. This shoulder 22 acts as a spacer to maintain a space or a -groove 24 between the tip 14 and the spacerl element 18.

The spacer element 18` is shown as Ihaving a central bore through its longitudinal axis, and this bore is of such a diameter that the stem may be snugly fitted through the bore. The spacer element is itted over and moved along the stem body until it abuts against the shoulder 22 of the tip 14. The spacer element 18 also includes the tapered portion 25 which permits the blade 50 to be received into the groove 24. As already described, the groove 24 is formed around the circumference of the tip when the spacer element 18 is abutted against the tip and its shoul-der 22. The blade tip is retained in this groove to maintain the blade in proper cutting position in cooperation with the blade guide 16.

The spacer element 18 includes an enlarged portion 26 and a reduced diameter portion 28. The enlarged portion 26 is of any suitable outside diameter and this will be the outside diameter of the main shaft of the instrument when assembled. The reduced diameter portion 28 is of such a diameter that it may receive and support the blade guide 16. A shoulder 30 is formed on the element 18 Where the reduced diameter portion 28 meets the enlarged portion 26, and the blade guide 16 is abutted against this shoulder in the assembled instrument.

The blade guide 16 includes a sleeve-like base 32 and an elongate body member 34 extending laterally outwardly at right angles to the base, and the elongate body member 34 is secured to the base 32 by any suitable means. The elongate body member carries a slot 36 therethrough which is adapted to hold a cutting blade S in a xed predetermined angular relationship to the longitudinal axis of the stern 10. As shown in FIGURES 3 and 4, the slot 36 is formed completely through the elongate body member 34 at a terminal end 38 of the body member. The slot 36 is formed at a -predetermined angle to the longitudinal axis of the stem so that a cone will be described when the blade is rotatably guided around the axis of the stern. The slot is formed in alignment with the groove 24 in order that the point of the blade carried by the slot may be .held in the groove 24 as shown in FIG- URES l and 2. The `depth of the blade guide 16 at the area of the slot is sucient to permit the slot to hold the blade in a firm position. Thus, there will be no shifting of the blade when the instrument is in use.

The terminal end portion 318 may be coextensive with the longitudinal axis of the elongate body member 34, but is shown as angling away from the axis of the body member 34. The particular angular positioning of the terminal end portion 38 serves to cooperate with -a preferred blade holder 40l in a manner that will be described in greater detail below.

The sleeve-like base 32 of the blade guide 16 includes a bore 42 through its longitudinal axis, and this bore 42 is of such a diameter as to t for easy rotation around the portion 28 of the spacer element 18 when the two elements 16 and 18 are assembled. The length of the sleevelike base 32 is shorter than the ylength of the portion 28 so that when the blade guide is mounted on the portion 218, a space 44 is left between the blade guide and adjoining elements. In its assembled position, the blade guide 16 is abutted against the shoulder 30 of the spacer element 18. In this mounted position, the blade guide 16 may be easily rotated about the longitudinal axis of the stem 10 because of the small space 44 and because of the Iparticular selection of diameters of the bore 42 as related to the portion 28.

The spacer element is of any suitable length to complete the instrument up to the handle `12. The spacer element 20 has a central longitudinal bore of the same diameter as that described for the spacer element 18, and the Outside diameter of the spacer 20 may be the same as the largest outside diameter of the spacer 18. When the spacer element 20 is assembled onto the stem 10, it will be seen that one end of the spacer element 20 abuts against the end of the portion 28 and thus the space 44 is formed between the spacer element 20` and the blade guide 16 as already mentioned.

Any suitable handle means may be provided fo-r the handle end of the stem 10. FIGURE 2 shows a preferred form of handle 12 which is removably mounted on the stem 10 and which functions to hold the entire instrument assembly together. The handle 12 includes a central longitudinal bore of a suitable diameter for receiving the end -of the stern 10. The bore is suiciently deep to permit the handle to tightly abut the end of spacer element 20. A thumbscrew 46 is threaded in bore 48 of the handle to hold the handle in any given position on the end of stern 10. The bore 48 is internally threaded to match external threads on the thumbscrew 46, and thus the thumbscrew can be lturned into the handle until it tightly engages the surface of the stern 10.

lFrom the above discussion, it can be seen that the assembled instrument provides a blade carrying and guiding device which is simple in construction and easily dis-A mantled for sterilization or interchanging of elements.- The entire device may be made of stainless steel o-r any other suitable material, and specific dimensions may be' adjusted to t varying needs.

It is 0f particular importance that the blade guide 16 may be easily interchanged in the instrumentV of this invention because various sizes of blade guides are used to provide varying cutting angles for a blade 50. It will be seen by comparing the blade guides of FIGURES 2 and 3, that a longer body portion 34 for the blade guide provides a higher location of the slot 36 through the end portion 38. Thus, in the FIGURE 3 blade guide la more obtuse angle is provided for the blade 50 in its relationship to the tip of the instrument. rIhe longer blade guide is useful to permit a larger icone of tissue to be removed from a body cavity, and the interchangeability of blade guides adapts the instrument to a Wider range of uses than heretofore possible. As an example of useful dimensions, the blade guides which may be made in accordance with this invention may vary in height from 11A: inches to 2 inches, and such blade guides will provide cutting angles varying from 20 to 45 in proportion to the increasing length of blade guide.

The blade 50 is a double edge blade which is pointed at its tip, and it is preferably held by the holder 40 as shown in FIGURES 1 and 2. As seen in FIGURES l and 2, the the blade 50 Imay be in the conguration of a thin, at blade, and cutting edges may be provided along the lateral edges of the blade in a well-known manner. Furthermore, theblade 50 is replaceable in the holder, and thus varying degrees of sharpness may be provided by interchanging blades in the holder.

The holder 40 is constructed to :carry the blade in any conventional manner, such as by the fasteners 52 which t through openings in the blade itself. The holder includes la handle 54, and as shown in FIGURE 2, an extension of the handle portion includes the blade carrying means 52. In addition, the blade holder includes lever means 56 pivotally mounted on the handle by a pin 58 which acts as a fulcrum for the lever. The lever means 56 includes a sharpened end point 60 which cooperates with the blade guide 16 and blade 50 to grip a portion of the: cervix while tissue is being cut from the cervical os. The: end of the lever means 56 which is opposite the gripping end 60 is attached to the holder handle 54 by a spring 62' or by any other suitable means. 1n this manner the lever' means 56 includes a griping means 60 which may be- 'actuated by lightly depressing the handle 54 of the holder. When the handle 54 is depressed the'fulcrum point 58 is forced upwardly slightly and the spring 62 pulls the spring end of the gripping means down With the handle 54. This action causes the gripping point 60 to raise upwardly away from the blade 50 and an opening or gap is thereby made between the point 60 and the blade. When the handle 54 of the holder is released, the gripping point 60 returns to -a gripping position against the blade guide 16 and the `opening between the point 60 and the blade becomes smaller. Thus, it is possible to grip tissue within the described opening with the point 60 and this is done to hold the cervix in a rm position while tissue is being cut. The particular angle of the blade guide end portion 38 as related to the remainder of the elongate body portion of the blade guide 34 serves to cooperate with the gripping point 60. The end portion 38 provides a flat head which is parallel to the main axis of the gripping means 56, and the gripping point 60 is provided with a flat face which abuts against the point for better gripping action.

Having described the various elements and assembly of the surgical instrument of this invention, the use of the instrument will now be discussed. After selecting the proper size of blade guide, the instrument is assembled as described above. Then the blade is attached to the blade holder, and the blade is passed through the slot 36 of the blade guide 16 as shown in FIGURE 2. The tip of the blade is placed in the groove 24 lat the tip of the instrument and is retained in the groove during the use of the instrument. It will be seen that the size of blade guide selected will determine the angle of the blade to the main axis of the instrument, and thus the size of cone described by the cutting action. The instrument is then inserted into the body cavity where tissue is to be removed. When used for cold conization of the cervix, the tip 14 of the instrument is inserted into the cervical os while the handle 12 is being held in one hand by the surgeon. With the instrument in place for operation, the handle 54 of the blade holder may be grasped by the other hand of the same operator preparatory to the cutting of tissue from the cervix. The handle 54 is depressed slightly toward the main instrument so as to open a space between the gripping point 60 and the blade S0. Then the handle 54 is released andthe gripping point grasps a portion of the anterior lip of the cervix. In this manner the cervix is maintained in a lirm position while tissue is being cut from the cervical os. With the instrument in place and the gripping means holding the anterior lip of the cervix, the surgeon may now proceed to move the handle 54 of the blade holder about the longitudinal axis of the main instrument body While holding the handle 12 ina lixed position. Since the blade guide is rotatably mounted on the stem, the blade may be moved about a complete 360 circle, thus removing an entire conical circumference of tissue from the cervical os, if desired. It will be appreciated that the surgeon may release the gripping means periodically las the handle is being rotated about the circular path. The release of the gripping means is easily effected by depressing the handle 54 while it is being rotated. Also, downward pressure on the handle is periodically relieved, and the gripping means intermittently g-rasps a new portion of the cervix for each new location of the blade.

Using the procedure just described, a single operator may hold the entire instrument in place with his one hand while actuating the cutting blade with the other handle.

Further, the same operator may actuate the gripping means for holding the cervix in the area that the cut is being made, and the entire operation may be accomplished With a single instrument. It is a further advantage that the use of a double edged cutting blade in the instrument permits rotative movement of the blade in either direction of the circular path so that the cutting action may be accomplished with either edge of the blade at the choice of the operator.

Although this instrument has been described in its preferred form land with the use of a preferred blade holding means, it is contemplated that variations may be made in the construction Without departing from the scope of invention. For example, any suitable blade holding means may be used with this instrument, and it is possible to use a blade holder which does not include the gripping means described in the preferred embodiment. Also, it is contemplated that the blade guide means may take on a variety of configurations and may include means equivalent to the described slot for maintaining the blade at its predetermined angle. Furthermore, many structural changes are possible and are intended to be within the scope of 6 the present invention as set forth in the appended claims.

What is claimed is:

1. A surgical instrument for obtaining -a circumferential specimen of tissue from a body cavity comprising:

a stem having a tip at its one end and a handle at its opposite end, said tip having a groove for receiving -an end of a cutting blade;

a blade guide mounted on said stem at a fixed distance from the tip of the stem, and said blade guide having a body portion extending laterally from'the stem said blade guide being mounted for rotation about the longitudinal axis of the stem;

a slot through the body portion of said blade guide for carrying a cutting blade, said slot being formed at a predetermined angle towards the longitudinal axis of the stem and in alignment with said groove in the tip of the stem; and

a cutting blade positioned in said slot of the blade guide, and extending from said slot to the tip of the stem, the end of said cutting blade being received and guided by said groove in the tip, whereby said cutting blade is held in the instrument at a predetermined angle to the stem of the instrument.

2. A surgical instrument as set forth in claim 1, said groove being formed laround the complete circumference of said tip portion, whereby the blade may be rotated 360 about the longitudinal axis of the stem while the end of said blade is being retained within said groove.

3. A surgical instrument for use with a cutting blade for obtaining a circumferential specimen of tissue from a body cavity comprising:

a stem having a tip portion at its one end and a handle portion at its opposite end, said tip portion having an annular groove for receiving the end of a cutting blade;

a blade guide mounted on said stem at a distance from the tip of the stern, leaving a space between said blade guide and said tip for forming said annular groove, said blade guide being mounted for rotation on said stem, whereby the blad-e guide Iand its blade may be rot-ated 360 about the longitudinal axis of the stem;

a slot in said blade guide for receiving the body of a cutting blade, said slot being positioned at a predetermined angle toward the longitudinal axis of the stern and in alignment with said groove in the tip of the stem, whereby a blade may be inserted through said slot with the end of the blade being received in the groove and with a cutting edge of said blade occupying the space between the blade guide slot and the tip of the stern at a predetermined angle to the stem.

4. A surgical instrument as set forth in claim 3 including gripping means carried by said instrument for holding the specimen of tissue while it is being cut and subsequently removed.

5. A surgical instrument for obtaining a circumferential specimen of tissue from -a body cavity comprising:

a stem having a tip at its one end and a handle at its opposite end, said tip having a circumferential groove for retaining the tip of a cutting blade;

a blade guide rotatably mounted on said stem at a xed distance from the tip of the stem, and said blade guide having a body portion extending laterally outwardly from the stem;

a slot through the body portion of said blade guide for carrying a cutting blade, said slot being formed -at a predetermined angle toward the longitudinal axis of the stem Iand in alignment with said groove in the tip of the stern;

a cutting blade carried by a blade holder, said cutting blade being positioned in the slot of the blade guide and extending from the slot to the tip of the stem, the end of said cutting blade being retained and guided by said groove in the tip, whereby the cutting i7 lblade is held in the instrument at a `predetermined angle to the stem of the instrument; and

gripping means 'carried by said blade holder and mounted for cooperation with said blade guide and said blade, whereby said gripping means may be actu-ated to grasp a part of a body organ adjacent to the tissue being cut by the blade.

6. The surgical instrument as claimed in claim 5 wher-ein said gripping means is mounted on one end of a lever, said lever being fulcrumed on the blade holder and a second end of the lever being attached to the blade holder whereby movement of the holder in one direction will cause the lever to move about a fulcrum, carrying said gripping means in an opposite direction.

7. A surgical instrument for obtaining a circumferential specimen of tissue from a body cavity, said instrument being assembled from a plurality of elements and comprising:

an elongate stem having Aa tip at its one end and a handle portion at its opposite end, said tip including a groove around its circumference for receiving the end of a cutting blade;

a first spacer element mounted on said stem adjacent to the tip of the stem, and la second spacer element mounted adjacent to the handle portion of the stem;

a blade guide rotatably mounted on said stern intermediate said spacer elements and in abutting relationship to the spacer elements, said blade guide having an elongate body portion extending laterally outwardly from the stem;

a slot through the body lportion of said blade guide for carrying a cutting blade, said slot being formed at a predetermined angle toward the longitudinal axis of the stem and in alignment with said groove in the tip of the stem whereby a cutting blade may be positioned through the slot with the end of the cutting blade retained in the groove of said tip;

a handle mounted on the handle portion of said stem adjacent to said second spacer element, said handle including means for fixing and releasing the handle onto the stem.

8. A surgical instrument for obtaining a circumferential sp-ecimen of tissue from a body cavity, said instrument being assembled from a plurality of elements and comprising:

an elongate'stem having a tip at its one end and a handle portion at its opposite end, said tip including a groove around its circumference for receiving the end of a cutting blade;

a first spacer element mounted on said stem adjacent to the tip of the stem, and a second spacer element mounted adjacent to the handle portion of the stem;

a blade guide rotatably mounted on said stem intermediate said spacer elements and in abutting relationshi-p to the spacer elements, said blade guide having an elongate body portion extending laterally voutwardly from the stem;

a slot through the body portion of said blade guide,

said slot being formed at a predetermined angle toward the longitudinal axis Of the Stem and in alignment with said groove in the tip of the stem; and

a cutting blade carried by a blade holder, said cutting blade being positioned in the slot of the blade guide and extending from the slot to the tip of the stem, the end of said cutting blade being held by said groove in the tip, whereby the cutting blade is held in the instrument at a predetermined angle to the stem of the instrument.

9. The surgical instrument as described in claim 8 where said blade holder further includes a gripping means mounted for cooperation with said blade guide and said blade, whereby the gripping means may be actuated to grasp a part of a body organ adjacent to the tissue being cut by the blade.

References Cited UNITED STATES PATENTS 1,127,948 2/1915 Wappler 12S-311 X 2,730,101 1/1956 Holman 128-305 2,839,051 6/1958 Chester 128--2 2,949,490 8/ 1960 Westcott 128-2 3,147,749 8/ 1964 Marsh 128-2 FOREIGN PATENTS 790,267 2/ 1958 Great Britain.

RICHARD A. GAUDET, Primary Examiner.

SIMON BRODER, Examiner. 

1. A SURGICAL INSTRUMENT FOR OBTAINING A CIRCUMFERENTIAL SPECIMEN OF TISSUE FROM A BODY CAVITY COMPRISING: A STEM HAVING A TIP AT ITS ONE END AND A HANDLE AT ITS OPPOSITE END, SAID TIP HAVING A GROOVE FOR RECEIVING AN END OF A CUTTING BLADE; A BLADE GUIDE MOUNTED ON SAID STEM AT A FIXED DISTANCE FROM THE TIP OF THE STEM, AND SAID BLADE GUIDE HAVING A BODY PORTION EXTENDING LATERALLY FROM THE STEM SAID BLADE GUIDE BEING MOUNTED FOR ROTATION ABOUT THE LONGITUDINAL AXIS OF THE STEM; A SLOT THROUGH THE BODY PORTION OF SAID BLADE GUIDE FOR CARRYING A CUTTING BLADE, SAID SLOT BEING FORMED AT A PREDETERMINED ANGLE TOWARDS THE LONGITUDINAL AXIS OF THE STEM AND IN ALIGNMENT WITH SAID GROOVE IN THE TIP OF THE STEM; AND A CUTTING BLADE POSITIONED IN SAID SLOT OF THE BLADE GUIDE, AND EXTENDING FROM SAID SLOT TO THE TIP OF THE STEM, THE END OF SAID CUTTING BLADE BEING RECEIVED AND GUIDED BY SAID GROOVE IN THE TIP, WHEREBY SAID CUTTING BLADE IS HELD IN THE INSTRUMENT AT A PREDETERMINED ANGLE TO THE STEM OF THE INSTRUMENT. 